75. Periodic Health Assessment/Screening Flashcards
Profitez des occasions opportunes pour effectuer l’examen médical périodique de manière proactive (c.-à-d. aborder le maintien de la santé même lorsque les patients consultent pour des préoccupations n’ayant aucun lien).
Adaptez l’examen médical périodique à chaque groupe de patients en fonction de leurs spécificités (c.-à-d. respecter les critères d’inclusion ou d’exclusion pour chacune des manoeuvres/interventions, par exemple les critères pour la mammographie et le dosage de l’antigène prostatique spécifique [APS]).
Lorsque le patient demande à subir un test (p. ex., dosage de l’APS, mammographie) recommandé ou non,
* a) informez le patient des avantages et des limites du test de dépistage (c.-à-d. sensibilité et spécificité).
* b) Donnez vos conseils au patient concernant les implications reliées à l’exécution du test.
Restez à jour avec les nouvelles recommandations concernant l’examen médical périodique. Évaluez de façon critique leur utilité et leur application à votre pratique
Consider Pap screening for anyone with a cervix to who?
25-69yo q3y
Describe Pap screening if ≥ 70yo
- stop if 3 successive negative Pap tests in last 10 years
- Consider 21-69yo as per SOGC
- Consider 21-65yo as per INSPQ
Who to screen with HPV ? (2)
- Primary HPV test screening for anyone with a cervix from from 25-65yo q5y is preferred over regular pap screening as per INESSS
- (but will only be implemented by 2025 in Quebec)
Describe HPV testing results
HPV 16 or 18 positive should be referred to colposcopy
Other HPV positive results can be triaged by cytology (pap)
* If cytology does not warrant colposcopy referal, follow-up one year with HPV testing
* If HPV positive on repeat, refer to colposcopy
* If HPV negative, return to regular screening (HPV q5y)
Describe mammogram screening
- Consider in women 50-74yo q2-3y
- CTFPHC recommends shared decision-making with women (avoiding harms vs. modest absolute reduction in breast cancer mortality)
Describe Colorectal Cancer screening
Consider 50-74yo RSOSi q2y or flexible sigmoidoscopy q10y
When to screen for colorectal cancer sooner ?
- If risk (1st degree relative ≤60yo CRC, high risk adenomas, or 2+ relatives)
- consider screening colonoscopy at 40yo or 10y prior to index case
Describe lung cancer screening
Consider 55-74yo with ≥30 py smoking history (current or quit <15y ago) low-dose CT q1y x 3
Describe Prostate Cancer screening
CTFPHC recommends against screening with PSA
* Urological associations suggest discussing risks and benefits of PSA screening with patients >50yo (or >40yo if fam hx or african american) with >15y life expectancy)
* Meta-analysis found no statistically significant differences in prostate cancer-specific mortality or all-cause mortality
* Overdiagnosis up to 67% for PSA screening (leads to unnecessary biopsy and treatment of clinically insignificant prostate cancer)
* Harms of screening include infection, hospitalization, death
Describe : Abdominal Aortic Aneurysm screening
Consider Men 65-80yo with one-time screening ultrasound for abdominal aortic aneurysm
Describe : Visual Acuity screening
- CTFPHC recommends against screening for vision impairment in community-dwelling adults aged 65 years and over (weak recommendation; low quality evidence)
- Consider screen at school age
Describe Hypertension screening
> 18yo at all visits or earlier if risk
Consider >3y
Describe Osteoporosis screening
≥ 65yo BMD or earlier if risk
Describe diabetes screening
- ≥40yo A1C or FPG q3y or earlier if high risk (FINDRISC)
- CTFPHC recommends not screening patients low-moderate risk (using validated calculator such as FINDRISC)
Describe Hyperlipidemia screening
≥40yo non-fasting lipids q5y (annually >20%) or earlier if risk
Describe alcohol intake recommendations
- ≤10 drinks/w (≤2/d) for women
- ≤15 drinks/w (≤3/d) for men
Describe exercise recommendations
150 min/semaine d’exercice d’intensité modérée à vigoureuse
Describe Vitamine D recommendations
- Vitamin D 400-2000 IU daily
- If age>50 years (or risk) 800-2000IU daily
Describe Calcium recommendations
- Calcium 1200 mg/d from diet
- increase to 1500-2000 mg/d if pregnant or lactating)
Describe folic acid recommendations
Folic acid 0.4-1mg daily for all women of childbearing age
Résume les dâtes des dépistages suivant :
* Pap tests
* HPV
* DB
* DLPD
* PSA
* Mammogram
* Colorectal cancer
* Lung cancer
* Abdominal Aortic Aneurysm
* Oesteoporosis
